Request for InformationLoading...* Denotes RequiredFirst NameLast NameBirthdateBirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Primary Program of InterestAdult-Gerontology Primary Care Nurse Practitioner (Certificate)Adult-Gerontology Primary Care Nurse Practitioner (M.S.N.)Biomedical Sciences (M.B.S. or M.A.)Cardiovascular Science- Perfusion (M.S.)Clinical Psychology (Psy.D.)Dental Medicine (D.M.D.)Doctor of Nursing Practice (D.N.P.)Nurse Anesthesia (D.N.A.P.)Nurse Anesthesia (D.N.A.P.) Completion ProgramNurse Leadership in Global Health (M.S.N.)Nursing - All Graduate Nursing ProgramsOccupational Therapy (O.T.D. or M.O.T.)Optometry (O.D.)Osteopathic Medicine (D.O.)Pharmacy (Pharm.D.)Physical Therapy (D.P.T.)Physical Therapy (D.P.T.) - Hybrid ProgramPhysician Assistant (M.M.S.)Podiatric Medicine (D.P.M.)Precision Medicine (Dual Degree Certificate)Precision Medicine (Dual Degree M.S.)Precision Medicine (Standalone Certificate for Professionals)Public Health (Dual Degree M.P.H.)Public Health (Standalone Degree for Professionals)Speech-Language Pathology (M.S.)Veterinary Medicine (D.V.M.)Do you want information about MWU's SLP Leveling Program?Do you want information about MWU's SLP Leveling Program?YesNoAre you a community college student?Are you a community college student?YesNoPlanned Enrollment TermSummer 2026Fall 2026Summer 2027Fall 2027Summer 2028Fall 2028Email AddressZip CodeWould you be willing to share additional information about yourself?Would you be willing to share additional information about yourself?YesOther Programs of InterestAdult-Gerontology Primary Care Nurse Practitioner (Certificate)Adult-Gerontology Primary Care Nurse Practitioner (M.S.N.)Biomedical Sciences (M.B.S. or M.A.)Cardiovascular Science- Perfusion (M.S.)Clinical Psychology (Psy.D.)Dental Medicine (D.M.D.)Doctor of Nursing Practice (D.N.P.)Nurse Anesthesia (D.N.A.P.)Nurse Anesthesia (D.N.A.P.) Completion ProgramNurse Leadership in Global Health (M.S.N.)Nursing - All Graduate Nursing ProgramsOccupational Therapy (O.T.D. or M.O.T.)Optometry (O.D.)Osteopathic Medicine (D.O.)Pharmacy (Pharm.D.)Physical Therapy (D.P.T.)Physical Therapy (D.P.T.) - Hybrid ProgramPhysician Assistant (M.M.S.)Podiatric Medicine (D.P.M.)Precision Medicine (Dual Degree Certificate)Precision Medicine (Dual Degree M.S.)Precision Medicine (Standalone Certificate for Professionals)Public Health (Dual Degree M.P.H.)Public Health (Standalone Degree for Professionals)Speech-Language Pathology (M.S.)Veterinary Medicine (D.V.M.)Campus of InterestDowners Grove, IllinoisGlendale, ArizonaEither Campus (IL or AZ)Mobile PhoneDo you wish to be contacted by Midwestern University via the mobile phone listed on this form? Contact methods may include phone calls or text messaging.Do you wish to be contacted by Midwestern University via the mobile phone listed on this form? Contact methods may include phone calls or text messaging.YesMailing AddressMailing AddressCountryStreetCityRegionPostal CodeIs your permanent home address different?Is your permanent home address different?YesPermanent AddressPermanent AddressCountryStreetCityRegionPostal CodeCurrent School NameCurrent School CEEBWhen will you be graduating from your current school?When will you be graduating from your current school?JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031201920202021202220232024202520262027hidden address typeMailing AddressPermanent Addresshidden address priorityHigh PriorityNormal PriorityLow PriorityInactivepassing countrySubmit